Linkage 8/20: A New Face for Athlete Concussions

The link between sports-related concussions and severe brain injury has been percolating in the press for several years now, due mostly to the tireless reporting of Alan Schwarz at the New York Times. But until this week, the research was lacking a prominent face, with most of those found to have suffered from early dementia and even death after multiple concussions unknown to all but the biggest football fans. That changed Wednesday with an article by Schwarz with an impossible to ignore hook: what if Lou Gehrig didn’t have Lou Gehrig’s Disease? In the ensuing days, the story has gained traction around the world, but also generated some justifiable skepticism.

That speculation (based on particularly circumstantial evidence) was an extension of an article published this week by researchers with the Center for Study of Traumatic Encephalopathy, which has led the way on the link between concussion and brain disorders in athletes. Previously, the group had found that deceased football players who had suffered multiple concussions during their careers, such as Lou Creekmur and Mike Borich, had several physical markers of Alzheimer’s disease despite dying at a young age. The new study shifts the focus to ALS, or amyotrophic lateral sclerosis, which was diagnosed in Lou Gehrig, prompting one of the most famous speeches in sports history.

In three athletes diagnosed with chronic tramuatic encephalopathy (CTE), the Alzheimer’s-like condition reported earlier, the researchers also found symptoms that resembled ALS: muscle weakness, atrophy, and spasticity. Autopsies on the athletes also found extensive death of motor neurons – the cause of ALS – but test showed that the damage resembled the brain damage seen in CTE rather than typical ALS damage. That suggests that brain traumas suffered during athletic competition can produce damage that simulates not one, but two of the most frightening neurological disorders. With exquisite timing, Carl Zimmer had a story at Discover the same day on just how such traumas could irreversibly damage neurons by stretching and contorting their string-like axons.

But while the science is interesting (and frightening), the link to Gehrig is shakier. Though the baseball player does not appear in the scientific article, the authors use Gehrig as a prominent example in the New York Times article, and cite newspaper records of the famous Ironman suffering head injuries in games but returning to play again the next day. But since his remains were cremated and his medical records remain confidential, there’s no way to tell whether Gehrig truly had ALS or the CTE-related faux-ALS described in the new article. That’s one of many criticisms Gary Schwitzer raises in his critique of the NYT article, alongside a neurologist urging caution regarding a journal publication based on a mere three case studies.

The linking of Gehrig to concussion-related brain damage is more than just an eye-catching lead; it also helps scientists deliver the message about an esoteric piece of science that could be relevant to millions of child and adult athletes. Lucie Bruijn, chief scientist for the A.L.S. Association described the value of Lou Gehrig for ALS research to Schwarz in the NYT article:

Dr. Bruijn described Gehrig as “an important fund-raising tool,” similar to the actor Michael J. Fox having Parkinson’s disease.

“It’s a name and a face that get people to understand what kind of a disease this really is,” she said. “It makes it more personal.”

Is borrowing that famous name and face for another neurological disorder based on flimsy evidence morally justifiable? It’s worth discussing.

A New England Journal of Medicine study finds that palliative care extends the average life of people with a difficult-to-treat form of lung cancer, something touched on recently in Atul Gawande’s must-read New Yorker piece on end-of-life care. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society, wonders what the reaction would be if the same results were reported for a new drug: “If that degree of improvement in life expectancy was seen in a clinical trial looking at survival after treatment with a new chemotherapy drug, there would be applause all over the place. “